A semi-biased commentary on British and American politics, culture and current affairs

Kristian Niemietz

Britain’s NHS idolaters cling to the Commonwealth Fund’s rosy but skewed assessment of the National Health Service like shipwreck survivors cling to floating wreckage

Brexit is not the only issue which reveals the intellectual limitations and paucity of vision of our politicians. Simply whisper the letters “NHS” and the vast majority of parliamentarians instantly turn into zombies, mindlessly repeating the same worn-out old paeans of praise to centralised government healthcare as though they were under the control of a hypnotist.

There are few better demonstrations of this pathology than yesterday’s segment on BBC This Week, in which Andrew Neil questioned uncritical acceptance of the Commonwealth Fund study (the only survey which routinely rates the NHS favourably) and Kate Andrews of the IEA gamely tried to advance the heretical notion that Britain might do well to learn from other advanced countries when it comes to organising healthcare delivery.

This went down like a lead balloon with bipartisan couch-warmers Anna Soubry and Alan Johnson, whose minds are both welded shut against any information that might suggest that the NHS is not, in fact, the “envy of the world”. Neither host Andrew Neil nor Kate Andrews are able to break through this veil of self-imposed ignorance:

Andrew Neil: Let’s just take the Commonwealth Fund now, because you politicians on both sides, you’re always using it —

Alan Johnson: Well, it’s the only one —

Andrew Neil: No, it’s not. It’s the only one in which the NHS does well, and actually in the Commonwealth Fund it measures inputs, not outputs, not patient care. Indeed, on the patient care – on actual health outcomes – even in the Commonwealth Fund the NHS comes tenth out of eleventh. The Guardian remarked on the Commonwealth Fund: “the only serious black mark against the NHS in Commonwealth Fund research was its poor record of keeping people alive”.

Alan Johnson: Yeah, America came eleventh, by the way, but…

Kate Andrews: Why America? Why not Germany or Belgium or Switzerland or France?

Alan Johnson: Because you came on here and said Trump has a point, are we supposed to talk about Sweden when you said Trump has a point?

Kate Andrews: You’re right, I did say Trump had a point, this whole point is that the NHS is failing, that doesn’t make America any better. Look, I’m from America, I’m not coming over here saying look, adopt the American system”, as I said in the video I wish both countries would look at Switzerland. But let’s stop painting this black and white decision because it’s not about USA versus NHS.

Alan Johnson: The Commonwealth Fund is the only one who measures things like health inequalities and fairness and how it affects the poorest —

Kate Andrews: What is fair about thousands more people in European countries surviving? What is fair about that? What is fair about the fact that 13,000 more people in Germany every year will survive the five most common types of cancer? What is fair about that?

Alan Johnson: [Becoming more incoherent and hysterical with every passing moment] You quote that without saying — as if the NHS was very keen for people to die of cancer —

Kate Andrews: No, of course they’re not, but we can do something about this —

Alan Johnson: One of the biggest problems is early reporting, is people going to their GP, particularly men —

Anna Soubry: We have – please, please, don’t tell me that you don’t have – depends on where you live —

Kate Andrews: The waiting times for this country are appalling compared to their European counterparts.

Anna Soubry: [Disingenuously talking about same-day emergency appointments rather than scheduled GP appointments] Excuse me. Your GP, it depends exactly where you live, because certain GP surgeries like mine, I can see my GP if I want to on the morning that I have – I can ring up and can get in straight away. It depends where you live —

Kate Andrews: That doesn’t sound like a very fair system. It doesn’t sound like a postcode lottery is a very fair system.

Anna Soubry: No, it’s not a postcode lottery.

Kate Andrew: Well he [Alan Johnson] is talking about fairness, and that’s what the NHS is good at, but you were talking about a postcode lottery system. There’s nothing fair about that system, and there’s not a lot that’s very good about it either.

So the NHS is perfect, equality of dismal outcome is preferable to aspiring toward excellence, and if you are one of those people whose deaths would have been prevented by another, superior healthcare system it’s your own stupid fault for not seeing your GP (the unnecessary gatekeeper to practically all NHS care) on time. So say Tory wets and Labour centrists alike.

This is mental subservience to the Cult of the NHS, pure and simple. Every day, the high priests of the NHS surpass themselves in new feats of bias confirmation. One might think that the NHS coming second from last in the rather key metric of keeping people alive might give pause for introspection, but throw up any fact or scenario which suggests that the NHS is inferior and immediately two things happen.

Firstly, up goes the wall of ignorance and denial. Why are you fussing about health outcomes anyway, they splutter. Don’t you know that fairness, ease of access and cost-effectiveness are the only metrics worth considering? And if that doesn’t work, then out comes the good old US/UK false dichotomy, where NHS defenders pretend, quite slanderously really, that anybody who questions the NHS model or expresses an interest in learning from other countries secretly wants to emulate the US system.

The Commonwealth Fund study is the outlier among health system rankings, because it pays little attention to outcomes – it is mainly based on survey responses and general system characteristics. But it has one category which does relate to outcomes, and in that category, the UK comes out 10th out of 11 countries. So even the preferred study of NHS cheerleaders confirms that in terms of outcomes, the NHS is one of the worst systems in the developed world.

Niemietz concludes:

The jingoism of Little Englanders is sometimes unedifying, but it is not nearly as cringeworthy as the NHS patriotism of the left. The NHS is the country’s most overrated institution. It is the Carling of healthcare systems. It achieves nothing that dozens of other healthcare systems do not also achieve, and usually better – and it’s time we admitted that to ourselves.

I made the same point in a television interview several years ago, pointing out that if you want to make a staunchly internationalist, post-patriotic left-winger sound like the stereotypical swivel-eyed Ukipper all one has to do is whisper the letters “NHS”, at which point they will immediately start ranting about British superiority and exceptionalism, waxing lyrical about how we alone have unlocked the secret of compassionate, universal healthcare delivery, while the other, benighted nations of the world look on at us in envy.

If the NHS is ever to be meaningfully reformed, if healthcare outcomes are ever to improve in Britain relative to the countries which are overtaking us, this wall of ignorance and denial must be torn down. But just from the facial expressions and physical demeanour of Anna Soubry and Alan Johnson in this BBC This Week segment, you can see that they will not be reasoned with. And if politicians who style themselves as pragmatic centrists cannot take the emotion out of an argument and drop the NHS hagiography for an honest discussion of healthcare reform, what chance is there?

This is a cult, plain and simple. When people cannot look dispassionately at a government service but instead debase themselves by sanctifying it (as though universal healthcare were in any way unique to Britain), observing its holy days, quoting its founders and worshipping its historical figures, what you have is a cult.

–

Support Semi-Partisan Politics with a one-time or recurring donation:

–

Agree with this article? Violently disagree? Scroll down to leave a comment.

Brave and principled defenders of Our NHS? The junior doctors would knife Aneurin Bevan’s vision in the back and happily serve an Evil Tory privatised healthcare system (how awful) if the price was right

Few people have been pronounced more saintly in 2016 than the holy NHS Junior Doctors, whose brave, principled and not-at-all-about-money industrial dispute with Jeremy Hunt and the Evil Tor-ee government has seen these humble, altruistic folks fight bravely and against the odds to safeguard the future of Our Blessed NHS.

Oh, wait. Nope. Turns out that most of those cherub-faced stethoscope swingers would throw the NHS under the bus and see the National Health Service privatised if it meant more money flowing into their pockets.

While I never believed for a second that the junior doctors’ strike was a People’s Struggle against the demonic forces of neoliberalism, I did believe that most junior doctors had convinced themselves of it. I was under the impression that they sincerely believed that that they were fighting The Just Cause on behalf of The People. Slogans like “Save our NHS” were everywhere, after all, and we always find it easy to convince ourselves that what is good for us also happens to be good for everybody, even if in roundabout ways.

And yet, in a recent survey of almost 10,000 junior doctors, 93% said they would accept “complete privatisation” of the NHS if it resulted in “substantially” increased salaries. Surely, some will dismiss these figures as a vicious smear, while others will accuse junior doctors of hypocrisy and opportunism. I think neither response is appropriate.

In practice, many doctors already act in accordance with the preferences expressed in this survey. Last year, about 8,600 UK-trained doctors went to work abroad, with Australia being a particularly popular destination. Australia has a universal public insurance system, in which the government commissions and pays for most healthcare, but in which the delivery is largely private and market-based. They are not doing anything immoral, because there is nothing immoral about private, market-based healthcare; in fact, the Australian system produces some of the best outcomes in the world. Come to think of it, even in the UK, most GPs are self-employed, not NHS employees. This means that technically, they are part of the dreaded – whisper it – private sector.

It would, however, suit junior doctors to quit the populist, anti-capitalist posturing. And the rest of us should try to keep our anti-capitalist knee-jerk responses in check. Even when it comes to healthcare.

Niemietz is kinder and more understanding in his piece than I am inclined to be. Personally, I think that the junior doctors’ strike was just another example of the NHS Industrial Complex – that vast connected web of connected special interests who have a direct stake in the world’s fifth largest employer continuing to operate along broadly the same lines as it does at present – flexing its muscles and throwing the entire country under the bus for their own economic gain. But that’s just cynical old me.

There is no disputing, however, that nearly every tawdry public (and private) sector dispute in modern history has been justified by the protagonists on the supposed grounds of “public safety”, whether it is London Tube drivers suddenly becoming concerned about safety on the Underground in time to tack an extra day onto their Christmas holidays, Southern Rail train drivers convinced that taking over responsibility for opening and closing their train doors will lead to regular platform bloodbaths, or the sainted junior doctors.

We have known since May that pay was the only real red line for junior doctors, though surprisingly none of their placards made reference to the desire for more cash – they chose instead to go with their “Save Our NHS” angle instead, to elicit maximum public sympathy (by whipping up maximum public fear). We have also known, thanks to the steady stream of junior doctors moving abroad to work for other, better healthcare systems than our own anachronistic NHS, that their supposed high-minded commitment to socialised, government-provided healthcare is often outmatched by the desire for a bigger pay cheque and a larger slice of finite taxpayer funds.

But now we find out that not only would many junior doctors consider abandoning the NHS and selling their services to hospitals in other countries, but that they would actively support the tearing down of Our Blessed NHS and its replacement with a privatised system here in Britain. The commitment to socialised public healthcare is literally tissue paper thin with these people, even more flimsy than the home-made banners on which they proclaim themselves to be tireless warriors fighting to defend the Best Healthcare System in the World.

Will the revelation of this hypocrisy change anything? Probably not. The Guardian and other sycophantic leftist outlets will no doubt continue to gush over the various vested interests within the NHS Industrial Complex, as instructed by High Priests like Owen Jones:

Ask a striking junior doctor why they’re taking this action, and you won’t simply hear an eloquent spiel about their contracts. It’s the very future of the NHS – which they have committed their lives to – which they fear is at stake. There are the government’s policies of marketisation and fragmentation – yes, accelerating what previous administrations did – stripping the “national” from NHS.

But it is sneaky what Owen Jones does here, suggesting that people become doctors out of a desire to work in a large government bureaucracy rather than feeling the call of a vocation to heal. Other countries seem to manage to recruit and train doctors without danging the carrot of getting to work for a massive state-owned bureaucracy in front of them, but Jones would have us believe that we only have doctors and nurses because people are so dreadfully inspired by Aneurin Bevan’s rusting 1948 vision. Nonsense, of course, but very effective propaganda from the NHS Industrial Complex.

The NHS Industrial Complex is made up of many different actors, all with their own motivations. One has the ideological leftists like Owen Jones, whose entire worldview relies on supporting a monolithic state healthcare provider churning out a precisely equally dismal service to every postcode in the UK. Then one has the worker bees within the organisation itself, whose medical or bureaucratic expertise rarely qualifies them to pass judgment on the optimal healthcare system for a country of 65 million people. And then one has the vast supply chain serving the beast, which is motivated primarily by a desire to preserve and expand existing revenue streams and avoiding risky disruption.

How fortunate that this cast of villains and useful idiots is able to hide behind the junior doctors – most of whom are eminently decent people supporting a superficially worthy cause – as they press for the preservation of the status quo, the scuttling of reform and a wider pipeline direct from the bank account of every UK taxpayer direct to the fifth largest organisation in the world.

But perhaps now that we know that the NHS Industrial Complex’s most photogenic spokespeople are actually more than happy to upend the whole system, spit on Britain’s national religion and see the NHS fully privatised so long as the pay rise outweighs the public vilification, the junior doctors’ collective halo might tarnish a bit.

The state is as large and active as it has ever been, yet millions of us sincerely believe that we live in a Thatcherite/Reaganite dystopia

Pick up any bestselling left wing political book or listen to any prominent left wing commentator on television or radio today, and chances are that you will almost immediately be confronted with the N-word.

We live in a neoliberal age now where the Corporations and the Bad people and the Profit do bad things to the Society and the Good People and the Community. Rich people take money from the pockets of poor people because neoliberalism.

Neoliberalism is destroying Our NHS with the profits and the privatisation and the One Per Cent. Local shops and artisan bread makers and steel manufacturers are put out of business because neoliberalism and the giant supermarkets and the GM food. George Osborne gives your money to millionaires and billionaires because neoliberalism, and wants to socially cleanse London because neoliberalism and the housing crisis. Heartless Iain Duncan Smith kills disabled people in his spare time because neoliberalism. Save Our NHS from neoliberalism, Saint Bevan [genuflect].

Britain only re-elected this hateful neoliberal Tory government with an increased majority and share of the vote because the neoliberal media confused the minds of the people with their neoliberal propaganda and made them forget just what a star-spangled awesome prime minister Ed Miliband would have been.